One-Year Survival Rate after Thoracotomy for Left Ventricular Assist Device Implantation Compared with Sternotomy

Abstract

Possible benefits of a left anterior thoracotomy approach for left ventricular assist device implantation have been reported recently, however, data of mid-term outcomes after this approach are scarce. This study compared the mid-term survival rate of a left anterior thoracotomy approach versus sternotomy. This is a single-center retrospective study of 264 patients who underwent centrifugal-flow left ventricular assist device (HeartWare, HVAD) implantation between 7/2011 and 12/2018 at our institution. After excluding 37 device exchange procedures and 17 patients who underwent any cardiac surgery prior to the implantation during the same hospitalization, 210 patients constituted the study cohort. The cohort was divided in two groups: a left anterior thoracotomy approach (LAT group; N = 42) and a full sternotomy approach (FS group; N = 168). The LAT group had higher rate of ischemic cardiomyopathy, cerebrovascular accident and previous cardiac surgery compared to the FS group. Although median operative time was longer in the LAT group (LAT; 255 mins vs FS 211 mins, P < 0.001), median cardiopulmonary bypass time was shorter (LAT; 52 mins vs FS; 68 mins, P = 0.040). The LAT group, compared to the FS group, had shorter ventilator support time (LAT; 22 hours vs FS; 36 hours, P = 0.001), less postoperative blood transfusion use (LAT; 57 % vs FS; 73 %, P = 0.042) and lower rate of moderate right heart failure (LAT; 33 % vs FS; 76 %, P < 0.001). A total survival rate at one-year after the implantation was 76.0 %. There was no statistical difference in one-year survival rate between the two groups (LAT; 73.2 % vs FS; 76.7 %, P = 0.632). Mid-term survival was similar between a left anterior thoracotomy with upper partial sternotomy and a full sternotomy. We will continue to follow these patients to compare the long-term outcomes between the two groups.